Telemedicine in Humanitarian Aid and Relief

The Growing Call to Action 

In recent days, news and media outlets have been packed with coverage on the ongoing humanitarian crisis in Europe. Most of us, including health professionals and clinicians, situated hundreds and thousands of miles away are left wondering - how can we help? Unfortunately, though devastating and one more is too many, this crisis is only one of many emergency crises that make it to modern global headlines. 

In 2020, along with the consequences of climate change and the then-new outbreak of COVID-19, global extreme poverty rose for the first time. Médecins Sans Frontières (MSF) alone provided assistance in over 90 countries and additionally, in 2021, it was estimated that over 450 million children were living in conflict zones. In light of recent events in Europe, we can probably now expect this number to be even higher. 

Whether dealing with conflict situations, natural disasters, or extreme poverty, the growing call for humanitarian aid across different parts of the world means that organizations are having to persistently look for innovative ways to deliver relief more efficiently and sustainably. Djibouti, for example, is set to become the first country with 100% sustainable energy in all refugee camps. In Eastern Chad, hydroponics is being used to grow plants without soil. So why should healthcare be any different? What innovative but well-established methods can we provide from the healthcare sector to provide humanitarian assistance?

Trends in Telemedicine 

Fuelled by the pandemic and increasing trends to move our lives online, the use of telemedicine has increased exponentially over the last few years. In the first quarter of 2020, at the start of the COVID-19 pandemic alone, the use of telehealth increased by 50% compared to the same period in 2019.

Aside from developed environments, telemedicine could also be leveraged in humanitarian environments for specific consultations and for multi-specialty expert input. Furthermore, new technologies have allowed for physical examinations to be done by healthcare professionals remotely, allowing even a greater proportion of aid workers to be situated anywhere in the world. Organizations such as the Swinfen Charitable Trust and MSF have already begun to offer asynchronous consultation services by experts to healthcare providers in developing countries. There is a huge potential for this to expand into live teleconsultations - here are the benefits, challenges, and their likely solutions.

Benefits 

Any Place, Any Language, Any Expert

‘Where there's a will there's a way’ - and telemedicine could be that way. Through telemedicine, any healthcare professional, as long as willing to engage, can be recruited swiftly no matter where they are based in the world.

According to UNICEF, their (physical) emergency deployments last, on average, 122 days. This creates a barrier for experts who, for personal or work commitments, are unable to be away from their home base for prolonged periods. With telemedicine, healthcare providers can continue with their daily lives, whilst offering up their free time to volunteer for emergency projects. 

Clinicians speaking specific languages are often required and can be sourced more easily across continents. Furthermore, medical interpreters can also be sourced from anywhere in the world and participate in virtual appointments alongside healthcare professionals, providing a truly multi-geography relief effort. 

Safety for Healthcare Professionals 

According to the 2021 Aid Worker Security Report, aid worker casualties remained high, with 475 aid workers being victims of major attacks in 2020. On top of violence, crowded conditions, poor quality shelters, and poor sanitation also increase the risk of communicable diseases in humanitarian settings. The Health and safety of aid volunteers should continue to be a top priority for relief projects and telemedicine allows for a proportion of healthcare workers to remain in safe conditions whilst working with patients in hazardous environments. 

Reduced Logistics and Costs 

Costs for travel, insurance, accommodation, and basic living expenses can be eliminated for those situated virtually. The time spent for administrative staff to organize these logistics can also be saved. 

Opportunities for Lesser Prioritized Specialties  

In most cases of crisis management, due to limited resources, emergency treatments are often prioritized over long-term preventive care or mental health support. However, it is well documented that most victims of humanitarian disasters will experience psychological distress, including one in five who will likely develop a mental disorder. Telehealth allows all specialties to take part in the effort. As long as the digital and electronic infrastructure has already been set up, even experts from other, often less prioritized specialties can continue to offer assistance. 

Challenges and Solutions 

Scaling Quickly 

Humanitarian crises are often unpredictable or arise spontaneously. Earthquakes, floods, and other weather events usually occur with little to no warning, making it difficult to prepare for a response prior. Even with increased accessibility offered by the internet, recruiting healthcare professionals, setting up legal support (such as malpractice and medical liability) and logistics require long lengths of time and may not be available as part of a swift and prompt response that is needed for an emergency. 

In the ideal setting, there would be a pre-established network of pre-verified healthcare professionals that could readily be activated as soon as a disaster occurs. Malpractice cover would be organized for them even before this and a turn-key logistic solution would ensure that resources would be utilized, even at short notice. 

Stable Internet and Electronic Resources 

Although a growing number of the world population has now got access to smartphones, connection to a telemedicine platform still relies on the supply of adequate electricity and reliable internet. This may not always be feasible in low-income countries, in areas of conflict, or in post-natural disaster projects, where infrastructure has been destroyed. Tablets and computers may also be required for a telemedicine platform to run smoothly, adding to costs. 

Communication between Field Workers and Online Clinicians 

To support the use of telemedicine, field workers are still required to provide clinical monitoring, logistical support, and physical treatments. Effective communication between field workers and online clinicians is essential for a coordinated response, with support being available for both parties on an around-the-clock basis. Medical notes must be kept virtual, to ensure optimal continuity of care and clinical guidelines need to be standardized for everyone. 

Development of Resource-Specific Protocols  

Many telehealth companies will have their own protocols for triage, prescription, and privacy. Clinical protocols and guidelines are often dependable on the resources available, both online and in the patient’s physical environment. In the world of humanitarian medicine, resources can differ vastly depending on the environment and the catastrophe that has taken place. Again, time, an invaluable resource in such situations, is often required to gather up-to-date medical research and combine this with a cost-benefit analysis to produce clear and concise protocols. Perhaps AI could help - algorithms could be trained to conduct cost-benefit analyses for specific scenarios with specified resources and make instantaneous clinical guidelines recommendations. 

Providing Value in a Humanitarian Crisis 

Across the globe, we are increasingly identifying ourselves as part of a wider, multicultural, and multinational society. As fellow human beings, we are showing solidarity and there has been a growing call to offer our assistance, no matter where in the world we are. 

We at Medcase have also been dedicated to doing our part in the current humanitarian crisis. As a network of remote, on-demand access to medical expertise, whether you are a healthcare professional or a company building a product to offer assistance, we are here to provide the opportunities and clinical logistical solutions. 

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